Provider First Line Business Practice Location Address:
3899 HAINES ST BLDG 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92109-6354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-775-2654
Provider Business Practice Location Address Fax Number:
858-246-6874
Provider Enumeration Date:
07/27/2010